Factor Structure and Equivalence of Maternal Resources for Care in Bangladesh,Vietnam, and Ethiopia

Maternal and Child Health Journal - Resources for care among women are crucial for children’s growth and development. The objectives of this cross-sectional study were to determine if: (1)...     

Maternal mortality in Matlab, Bangladesh: 1976-85

This paper reports findings from a study of maternal mortality in Matlab, Bangladesh during the 1976-85 period. The study employed a multiple-step procedure to identify maternity-related deaths to all reproductive-aged women within the study area during this period. A total of 387 maternal deaths were identified, resulting in an overall maternal mortality ratio of 5.5 per 1,000 live births. The introduction of a family planning program in half of the Matlab study area led to a moderate but significant reduction in maternal mortality rates, relative to the comparison area. This appears to have been primarily due to a reduction in the overall number of pregnancies in the treatment area, since among women who became pregnant, mortality risks remained high. The results of this study underscore the need for a broad-based service strategy that includes but is not limited solely to family planning, in order to achieve significant reductions in maternal mortality levels in settings such as rural Bangladesh.     

Maternal Near Miss: An Indicator for Maternal Health and Maternal Care

Maternal mortality is one of the important indicators used for the measurement of maternal health. Although maternal mortality ratio remains high, maternal deaths in absolute numbers are rare in a community. To overcome this challenge, maternal near miss has been suggested as a compliment to maternal death. It is defined as pregnant or recently delivered woman who survived a complication during pregnancy, childbirth or 42 days after termination of pregnancy. So far various nomenclature and criteria have been used to identify maternal near-miss cases and there is lack of uniform criteria for identification of near miss. The World Health Organization recently published criteria based on markers of management and organ dysfunction, which would enable systematic data collection on near miss and development of summary estimates. The prevalence of near miss is higher in developing countries and causes are similar to those of maternal mortality namely hemorrhage, hypertensive disorders, sepsis and obstructed labor. Reviewing near miss cases provide significant information about the three delays in health seeking so that appropriate action is taken. It is useful in identifying health system failures and assessment of quality of maternal health-care. Certain maternal near miss indicators have been suggested to evaluate the quality of care. The near miss approach will be an important tool in evaluation and assessment of the newer strategies for improving maternal health.     

Causes of Maternal Mortality Decline in Matlab, Bangladesh

Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR) of 322 per 100,000 livebirths despite the very low use of skilled care at delivery (13% nationally). This variation has also been observed in Matlab, a rural area in Bangladesh, where longitudinal data on maternal mortality are available since the mid-1970s. The current study investigated the possible causes of the maternal mortality decline in Matlab. The study analyzed 769 maternal deaths and 215,779 pregnancy records from the Health and Demographic Surveillance System (HDSS) and other sources of safe motherhood data in the ICDDR,B and government service areas in Matlab during 1976-2005. The major interventions that took place in both the areas since the early 1980s were the family-planning programme plus safe menstrual regulation services and safe motherhood interventions (midwives for normal delivery in the ICDDR,B service area from the late 1980s and equal access to comprehensive emergency obstetric care [EmOC] in public facilities for women from both the areas). National programmes for social development and empowerment of women through education and microcredit programmes were implemented in both the areas. The quantitative findings were supplemented by a qualitative study by interviewing local community care providers for their change in practices for maternal healthcare over time. After the introduction of the safe motherhood programme, reduction in maternal mortality was higher in the ICDDR,B service area (68.6%) than in the government service area (50.4%) during 1986-1989 and 2001-2005. Reduction in the number of maternal deaths due to the fertility decline was higher in the government service area (30%) than in the ICDDR,B service area (23%) during 1979-2005. In each area, there has been substantial reduction in abortion-related mortality—86.7% and 78.3%—in the ICDDR,B and government service areas respectively. Education of women was a strong predictor of the maternal mortality decline in both the areas. Possible explanations for the maternal mortality decline in Matlab are: better access to comprehensive EmOC services, reduction in the total fertility rate, and improved education of women. To achieve the Millenium Development Goal 5 targets, policies that bring further improved comprehensive EmOC, strengthened family-planning services, and expanded education of females are essential.Key words: Causes of death, Delivery, Health services, Health facilities, Healthcare, Maternal health, Maternal mortality, Obstetric care, Risk factors, Bangladesh     

Pre-hospital Care to Trauma Patients in Addis Ababa,Ethiopia: Hospital-based Cross-sectional Study

BackgroundTrauma is a major cause of morbidity and mortality worldwide. Prompt use of pre-hospital care is associated with reduced early and late morbidity and mortality from trauma. This study aimed to assess the time to reach the facility and the pattern of pre-hospital care provided for trauma patients.MethodsA cross-sectional study design with a structured interview questioner was used for patients presenting to Addis Ababa Burn Emergency and Trauma Hospital Emergency Department from April 1 to May 30, 2020.ResultOut of 238 interviewed patients, the most common means of transportation from the scene to the initial health facility were taxi 77(32.4%) and ambulance 54(22.7%). The time of arrival from the scene to the initial health care facility was within one hour, 133(56.1%) and in 1–3 hours 84(35.5%). Some form of care was provided at the scene in 110(46.2%) of cases. The care provided was bleeding arrest 74(31.1 %), removing from wreck 51(21.4%), splinting/immobilizing injured area 38(16%), position for patient comfort 19(8%), and others. Relatives were the most common care provider 49(45%) followed by bystanders 37(33.9%), trained ambulance staff 19(17.4%), and police 2 (1.8%). The main reasons for not providing care were lack of knowledge 79(61.2%), and lack of equipment 25 (19.4%).ConclusionThe study showed relatives and bystanders were the first responders during trauma care. However, ambulance utilization for pre-hospital care was low. There was trauma patients delay to arrive to hospital. Only half of the patients presented to the health facility within Golden hour.     

Determinants and Consequences of Adolescent Fatherhood: A Longitudinal Study in Ethiopia,India, Peru,and Vietnam

PurposeAdolescent parenthood is a major challenge in low- and middle-income countries (LMICs). However, the vast majority of the evidence has focused on adolescent motherhood. Little is known about adolescent fatherhood in LMICs. The aim of this study was to examine the determinants of early fatherhood and its consequences on a range of outcomes among adolescent males.MethodsThis study used three waves of longitudinal data from the multicountry Young Lives cohort study, specifically following a sample of 1,779 adolescent boys at ages 15, 19, and 22 years in Ethiopia, India, Peru, and Vietnam. Individual fixed effects models were conducted to investigate the sociodemographic determinants of adolescent fatherhood and the consequences of adolescent fatherhood on males' education, health, psychosocial well-being, and time use outcomes.ResultsThe results indicated that lower educational attainment, absence of the adolescent's mother and father from the home, larger household size, and poverty increased the likelihood of becoming an adolescent father by age 22 years. The results revealed that becoming an adolescent father was associated with a higher likelihood of school dropout, being overweight, smoking, greater internalizing problems, and less time spent on leisure activities and more time spent on caregiving responsibilities.ConclusionsHighlighting the experiences of young men as adolescent parents in LMICs, findings underscore the importance of prevention strategies to delay early parenthood for adolescent boys and multicomponent interventions to support young fathers and their unique health, socioeconomic, psychosocial, and behavioral needs.     

Maternal Care Coordination for Migrant Farmworker Women: Program Structure and Evaluation of Effects on Use of Prenatal Care and Birth Outcome

Nearly three fourths of the migrant farmworkers in the U.S. are Hispanic. Cultural and social barriers, along with constant travel, make coordination of care a significant concern for migrant health centers providing perinatal services to female farmworkers. As part of a demonstration project, a migrant-specific maternal care coordination program was developed that used bilingual staff, outreach services, lay health advisers, and a multistate tracking system. Following the initiation of the project, first-trimester entry into prenatal care and number of prenatal visits increased over a five-year period among the target population. Successful tracking methods provided outcome data on more than 80 percent of participants during the project period. The results of this study suggest that migrant health centers should focus on employing public health-oriented bilingual or bicultural health professionals and that an outreach strategy must be an integral part of a health care delivery system serving migrant farmworkers. Without these key ingredients, health care services will not be accessible or acceptable for this hard-to-reach population. Collaboration among the National Migrant Resource Program, the Migrant Clinicians Network, and the National Perinatal Association can facilitate development of a regionwide perinatal service system for female migrant farmworkers.     

Anthropometric,cognitive, and schooling benefits of measles vaccination: Longitudinal cohort analysis in Ethiopia,India, and Vietnam

ObjectiveTo estimate the associations between measles vaccination and child anthropometry, cognition, and schooling outcomes in Ethiopia, India, and Vietnam.MethodsLongitudinal survey data from Young Lives were used to compare outcomes at ages 7–8 and 11–12 years between children who reported receipt or non-receipt of measles vaccine at 6–18 months-of-life (n = ∼2000/country). Z-scores of height-for-age (HAZ), BMI-for-age (BMIZ), weight-for-age (WAZ), Peabody Picture Vocabulary Test (PPVT), early grade reading assessment (EGRA), language and mathematics tests, and attained schooling grade were examined. Propensity score matching was used to control for systematic differences between measles-vaccinated and measles-unvaccinated children.FindingsUsing age- and country-matched measles-unvaccinated children as comparisons, measles-vaccinated children had better anthropometrics, cognition, and schooling. Measles-vaccinated children had 0.1 higher HAZ in India and 0.2 higher BMIZ and WAZ in Vietnam at age 7–8 years, and 0.2 higher BMIZ at age 11–12 years in Vietnam. At ages 7–8 years, they scored 4.5 and 2.9 percentage points (pp) more on PPVT and mathematics, and 2.3 points more on EGRA in Ethiopia, 2.5 points more on EGRA in India, and 2.6 pp, 4 pp, and 2.7 points more respectively on PPVT, mathematics, and EGRA in Vietnam. At ages 11–12 years, they scored 3 pp more on English and PPVT in India, and 1.7 pp more on PPVT in Vietnam. They also attained 0.2–0.3 additional schooling grades across all ages and countries.ConclusionOur findings suggest that measles vaccination may have benefits on cognitive gains and school-grade attainment that can have broad educational and economic consequences which extend beyond early childhood.     

Correction to: Integrated Behavioral Health for Preschool Children in Pediatric Primary Care

The Journal of Behavioral Health Services & Research -     

2015年-2019年厦门市妇幼保健机构人力资源发展分析及对策研究

目的：通过对厦门市妇幼保健机构2015—2019年人力资源变化趋势的动态分析，发现厦门市妇幼保健机构人力资源发展方面所存在的问题，并针对问题提出相应建议。方法：以厦门市妇幼保健机构监测直报系统为基础，结合厦门市卫生健康委员会所提供的卫生人力资源数据，对厦门市妇幼保健机构人力资源数据进行统计分析。结果：近5年厦门市妇幼保健机构人力资源发展较快，但仍然存在总量不足、配置不合理、专业结构失衡及整体素质不高、人才引进与需求不匹配等问题。结论：面对妇幼保健机构人力资源发展过程中的诸多问题，应该科学合理增加人力资源总量；优化专业结构；加强继续医学教育与培训；科学设置岗位比例。     

Periods of child growth up to age 8 years in Ethiopia,India, Peru and Vietnam: Key distal household and community factors

Recent research has demonstrated some growth recovery among children stunted in infancy. Less is known about key age ranges for such growth recovery, and what factors are correlates with this growth. This study characterized child growth up to age 1 year, and from ages 1 to 5 and 5 to 8 years controlling for initial height-for-age z-score (HAZ), and identified key distal household and community factors associated with these growth measures using longitudinal data on 7266 children in the Young Lives (YL) study in Ethiopia, India, Peru and Vietnam. HAZ at about age 1 year and age in months predicted much of the variation in HAZ at age 5 years, but 40–71% was not predicted. Similarly, HAZ at age 5 years and age in months did not predict 26–47% of variation in HAZ at 8 years. Multiple regression analysis suggests that parental schooling, consumption, and mothers' height are key correlates of HAZ at about age 1 and also are associated with unpredicted change in HAZ from ages 1 to 5 and 5 to 8 years, given initial HAZ. These results underline the importance of a child's starting point in infancy in determining his or her growth, point to key distal household and community factors that may determine early growth in early life and subsequent growth recovery and growth failure, and indicate that these factors vary some by country, urban/rural designation, and child sex.     

基层医疗保健机构孕产妇保健服务利用现状与相关因素分析

目的 探究影响孕产妇利用保健服务的相关因素,并结合地区实际,提出了相关建议和措施.方法 对在我院进行保健服务的1558名孕产妇进行调查分析,结合实际情况用SPSS 18.0统计学软件进行系统分析.结果 文化程度、家庭年收入水平、居住地距离、职业和医保等因素对孕产妇保健服务利用影响较大;同时,在1 558名受访者中,接受孕前保健指导的比率相对较低,早孕检查、5次以上产检率和住院分娩率结果相对较高,说明近几年来孕产妇对保健服务利用的意识有所提高,但产后访视比例仅为21.76％,比例较低.结论 针对当前现状,研究认为,个人、基层医疗保健机构及卫生管理部门等各方应当分别在提高认识水平、提高服务水平及加强基层系统建设等方面进行改善,以提高孕产妇保健服务的利用,提高优生优育水平.     

Investigating Factor Structure of an Instrument to Measure Social Work Students' Preparedness for Managed Care Environments

Abstract

This study investigated the factor structure of an instrument to measure social work students' perceptions of preparedness to enter managed care environments. Exploratory statistical procedures to reduce data through principle component analysis identified nine factors with eigenvalues greater than 1.0. These factors include: perceived understanding of agency financial agendas, managing personal risk and liability, perceived understanding of agency documentation requirements, awareness of ethical and value conflicts in documentation, classroom preparation for documentation, understanding the fit between client advocacy and managed care agendas, worrying about law suits in employment settings, perceived understanding of managed care gatekeeping and service authorization, and perceptions of field preparation for documentation. Recommendations are made for utilizing this brief self-report instrument in training students for managed care settings.     

2010-2018年兰州市妇幼保健机构卫生资源配置情况分析

目的评价2010-2018年兰州市妇幼保健机构卫生资源配置的变化趋势,为兰州市妇幼卫生事业的可持续发展提供依据。方法对2010-2018年兰州市妇幼保健院上报的行政报表进行整理分析,计算其增长速度。结果兰州市妇幼保健机构各类资源总体呈增长趋势。床位数、卫生技术人员数和卫生总费用的定基比增长速度分别为218.10%、169.71%和524.07%,年平均增长速度分别为15.56%、13.20%和25.72%;卫技人员学历以本科及以上为主,职称以初级为主;门诊人次、住院人次、每名医生的门诊诊疗人次和承担的入院病人数的定基比增长速度分别为156.37%、242.68%、23.80%和65.47%,年均增速分别为12.49%、16.64%、2.70%和6.50%;每万人口床位数和卫技人员数9年间增长了149.26%、124.41%,年均增长12.96%、10.63%。结论 2010-2018年兰州市妇幼保健工作成绩显著,但仍需增加保健部技术人员,培养和引进高学历和高级职称人才。     

广州市荔湾区社区妇幼保健服务资源现状及评价

目的 了解并评价广州市荔湾区22个社区卫生服务中心妇幼保健服务资源的现状.方法 设计自填式问卷.对22个社区卫生服务中心的妇幼保健服务情况进行横断面的调查.结果 社区卫生服务中心妇幼保健网络健全,人员、场地、设备、服务项目能满足妇幼人群的基本需求,但社区妇幼保健服务比较局限,设备设施、人员素质有待进一步的改善和提高.结论 改善社区卫生服务中心妇幼保健工作设备设施,提高妇幼保健人员素质,可提高服务质量,并提升社区妇幼保健服务的整体水平.     

Maternal healthcare for women with physical disabilities in Northern Vietnam: perspectives of healthcare providers

BackgroundPregnancy among women with physical disabilities is common around the world; however, there are limited qualitative studies that explore the perspectives of healthcare providers toward pregnant women with disabilities outside of the Global North.ObjectiveThis article explores perspectives and experiences of maternal healthcare providers in the delivery of services to women with physical disabilities in Northern Vietnam.MethodsSemi-structured interviews were conducted with 14 healthcare providers who worked in public and/or private healthcare North Vietnamese facilities where maternal services were provided. Data were thematically analyzed.ResultsThe participants included six males and eight females. Ten were obstetricians/gynecologists, one was a doctor specializing in obstetric imaging diagnosis, three were midwives, and one was a midwife/assistant doctor. Four themes were identified. In the first theme, providers attached provisos to the right to motherhood including the view that the women were limited to one child and should undergo prenatal screenings for fetal abnormalities. In the second theme, the providers reported that disability was not incorporated into their education; this led to half of them lacking confidence in providing appropriate maternal healthcare services for women with physical disabilities. The third theme found that although women with physical disabilities were considered as a priority group, decisions around who was seen before others or provided with fee discount/exemption were left in the hands of staff. The fourth theme identified that some providers overlooked their needs for physical accessibility and independence.ConclusionThis study shows that maternal healthcare providers in Vietnam discounted the needs of women with physical disabilities. The needs of women with disabilities should be included in the training of maternal healthcare providers in Vietnam.